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Wednesday, April 24, 2013

Models for Information System Success for eHealth?

I am doing some research on electronic systems used by Research Ethics Boards in Canada. One of the models we are using to determine if systems are liked by ethics boards and their respective research communities is the DeLone and McLean model. This model has been used a lot in information systems success studies and there is a lot of literature on it.

What there is not a lot of (to my knowledge), is how the model can be applied to eHealth applications. A little bit of searching on the internet and I discovered it has been used by the eHealth people at the University of Victoria in British Columbia, and I think it is very interesting what they have done. Roughly expressed by them is a Benefits Evaluation model. The team at UVic has applied this to evaluating Canada Health Infoway projects, called the Infoway BE Framework. Coincidentally I recently read a CBC article that Infoway had saved a billionaire dollars by implementing Electronic Medical Record systems for physicians in Canada. After reading some of the comments by the public on the CBC website for this story, I reminded again of the old adage that the Return on Investment in healthcare is improve in quality of life.









 

E-health records saved medical system $1.3B in 6 years

Use of electronic records more than doubled from 2006-2012, from 23% to 56%

Posted: Apr 22, 2013 11:04 AM ET

Last Updated: Apr 22, 2013 4:22 PM ET

Health Minister Leona Aglukkaq (right), seen with Richard Alvarez, CEO of Canada Health Infoway in 2009, announced $500 million in funding four years ago to improve the implementation of electronic medical record systems, but the funding was held back for a year until the government received more information about how it would be spent. Health Minister Leona Aglukkaq (right), seen with Richard Alvarez, CEO of Canada Health Infoway in 2009, announced $500 million in funding four years ago to improve the implementation of electronic medical record systems, but the funding was held back for a year until the government received more information about how it would be spent. (Handout/Health Canada/Canadian Press)


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A study done for Canada Health Infoway, the federally funded organization set up to monitor and improve the use of information technology across Canada's health care system, has found that increased use of electronic medical health records has saved $1.3 billion over the last six years.
The study by PricewaterhouseCoopers LLP (PwC) examined the switch to electronic medical records (EMR) by family doctors from across Canada between 2006 and 2012 and found:
  • $800 million in administrative efficiencies (less time by staff pulling and filing charts or processing finding lab test results, less time by doctors reading and maintaining paper files).
  • $584 million in health system benefits (reduced duplicate diagnostic testing, reduced adverse drug events).
  • Improved chronic disease management and illness prevention (higher mammogram screening rates, higher pneumonia and flu vaccination rates).
  • Improved communication amongst care providers and with patients (less time spent repeating patient histories among care providers, electronic alerts prompting follow-up care for things like medication recalls.)
The study's methodology included a review of current research, national survey and cost data and interviews.
"In some cases, it's the sum of a lot of little things, " said Jennifer Zelmer, senior vice-president with Canada Health Infoway.
"When you're using electronic medical records, staff in a medical practice tend to spend less time … pulling charts, and they're able to use that time for clinical services," she added. "
And when you add that up those kinds of efficiencies, both in terms of chart pulls and in terms of tracking down test results, actually the value of that is quite significant."
The study's findings don't surprise Stephen McLaren, a family physician in Markham, Ontario. He says many patients already understand the efficiency of an electronic record, especially if their paper record or test results were ever misplaced.
"Their visit with their provider is a very inefficient, unproductive visit and very often means you have to come back," Dr. McLaren said.
McLaren says there's also better treatment of chronic illness because electronic medical records allow a doctor to easily spot trends in a patient's tests, over time.
"In the paper world, you have to flip through pages and pages and pages, hoping to catch onto a trend if there was one there to see."

Use of electronic records still growing

Despite the growing use of electronic medical records, only 56 per cent of patients have one. McLaren says their use continues to grow, as more and more patients ask for them.
Meanwhile, he says the next big step in this area is to link up health care institutions — hospitals, labs, nursing homes, and doctors offices — so that a patient's information can be shared more easily, while still protecting the privacy of the data.
In a press release, Health Minister Leona Aglukkaq encouraged provinces, territories and other stakeholders to keep working to increase the adoption of electronic medical records and other e-health technologies "so that Canadians can benefit from a better integrated health care delivery system," added Minister Aglukkaq.
"We expect significant additional gains as adoption grows, use matures, and connections to other care settings expand," said Richard Alvarez, Canada Health Infoway's president and CEO, in the same release.
Canada Health Infoway had set a target for half of Canadians to have electronic health records by the end of 2010. The federal government delayed $500 million in funding for the agency by one year, seeking more information about how the contribution would be spent.
A 2009 report from the federal auditor general found contracting and reporting problems in early efforts to move more Canadian health records online.